Provider Demographics
NPI:1376603704
Name:GREY, DEBORAH TAYLOR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:TAYLOR
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 BETHESDA PL
Mailing Address - Street 2:SUITE 602-A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3318
Mailing Address - Country:US
Mailing Address - Phone:336-768-8281
Mailing Address - Fax:336-768-5685
Practice Address - Street 1:2990 BETHESDA PL
Practice Address - Street 2:SUITE 602-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3318
Practice Address - Country:US
Practice Address - Phone:336-768-8281
Practice Address - Fax:336-768-5685
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2861119Medicare ID - Type UnspecifiedSOCIAL WORKER